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Hormone Foundation’s Patient Guide to the Management of Maternal Hypothyroidism Before, During and After Pregnancy. Chevy Chase, MD: Hormone Foundation. 2007. 2 p.

This fact sheet provides a patient guide to the management of maternal hypothyroidism before, during, and after pregnancy. The guide is based on clinical guidelines written to help physicians who are evaluating and treating various types of thyroid dysfunction in pregnancy. The authors note that pregnancy, even in women with no thyroid abnormalities, causes major changes in thyroid hormone levels. This fact sheet focuses on maternal hypothyroidism, a condition in which the mother has too little thyroid hormone. Readers are reminded that hypothyroidism can have harmful effects on pregnancy, so diagnosis and treatment are vital. Most cases of hypothyroidism worldwide are caused by not enough iodine in the diet. Although this is less common in the United States, the demands of pregnancy and breastfeeding increase the need for iodine. Another cause of hypothyroidism is Hashimoto’s thyroiditis, an autoimmune disease. The fact sheet reviews the typical symptoms of hypothyroidism, postpartum thyroiditis, recommended diagnostic tests during prenatal care, risk factors for thyroid disease, and treatment strategies. Readers are referred to the Hormone Foundation (www.hormone.org or 1–800–HORMONE) for more information. 2 figures.

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Iodine Deficiency FAQ. Falls Church, VA: American Thyroid Association. 2007. 1 p.

This brief fact sheet answers common questions asked about iodine deficiency. Iodine is essential for the production of thyroid hormone and must come from the diet because the body does not make iodine. Iodine is found in various foods and is present naturally in soil and seawater. The fact sheet lists the symptoms of iodine deficiency, which include goiter, hypothyroidism, and pregnancy-related problems. Other topics include the causes of iodine deficiency, diagnosing iodine deficiency in populations, and treatment approaches, which focus on prevention. The author notes that individuals in the United States can maintain adequate iodine in their diet by using iodized table salt; by eating foods high in iodine, including dairy products, seafood, meat, some bread, and eggs; and by taking a multivitamin containing iodine. A final section offers ideas for further reading, including the American Thyroid Association’s website at www.thyroid.org. 4 references.

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Iodine Deficiency. Falls Church, VA: American Thyroid Association. 2007. 3 p.

This fact sheet answers common questions asked about iodine deficiency. Iodine is essential for the production of thyroid hormone and must come from the diet because the body does not make iodine. Iodine is found in various foods and is present naturally in soil and seawater. The fact sheet lists the symptoms of iodine deficiency, which include goiter, hypothyroidism, and pregnancy-related problems. Other topics include the causes of iodine deficiency, diagnosing iodine deficiency in populations, and treatment approaches, which focus on prevention. The author notes that individuals in the United States can maintain adequate iodine in their diet by using iodized table salt; by eating foods high in iodine, including dairy products, seafood, meat, some bread, and eggs; and by taking a multivitamin containing iodine. A final section considers problems encountered in people who take too much iodine, including causing or worsening hyperthyroidism and hypothyroidism. Readers are referred to the American Thyroid Association’s website at www.thyroid.org for more information. 2 tables.

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Management of Thyroid Dysfunction During Pregnancy And Postpartum: An Endocrine Society Clinical Practice Guideline. Journal of Clinical Endocrinology and Metabolism. 92(8): S1-S47. August 2007.

Management of thyroid disease during pregnancy requires special considerations because pregnancy induces major changes in thyroid function, and maternal thyroid disease can have adverse effects on both the pregnancy and fetus. This document presents clinical guidelines for the management of thyroid problems present during pregnancy and during the postpartum period. The guidelines were created using the methodology of the United States Preventive Service Task Force (USPSTF). The guidelines stress the importance of avoiding maternal and fetal hypothyroidism because of potential damage to fetal neural development, an increased incidence of miscarriage, and preterm delivery. Maternal hyperthyroidism and its treatment may be accompanied by problems in fetal thyroid function. Autoimmune thyroid disease is associated with increased rates of miscarriage and with postpartum thyroiditis. Radioactive isotopes, used for diagnosis and treatment, should be avoided during pregnancy and lactation. More than half of the document consists of a detailed, annotated bibliography of research studies on which the guidelines are based. 426 annotated references.

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Natural History of Obesity: Differential Diagnosis, Clinical Types, and Age-Related Changes. IN: Bray, G.A. Metabolic Syndrome and Obesity. Totowa, NJ: Humana Press. 2007. pp 93-122.

This chapter about the natural history of obesity is from a book that presents an up-to-date survey of the current scientific understanding of obesity and the metabolic syndrome, as well as an overview of the most significant changes in the field in the past 30 years. This chapter is a transition from the basic concepts already discussed to a consideration of the types of clinical settings that are associated with increasing body fat. The author begins with the importance of including genetic factors as part of the discussion of the differential diagnosis of obesity. Polygenic causes of excess body fat include congenital disorder or genetic syndromes causing excess fat; and neuroendocrine causes of overweight can include hypothalamic causes of overweight, Cushing's syndrome, polycystic ovary syndrome (POS), growth hormone deficiency, hypothyroidism, and hyperparathyroidism. The chapter looks at age-related events that can precipitate increasing rates of fat deposition. The author stresses that weight gain in different times of life often has different causes. One section considers behavioral, psychological, and social factors, including restrained eating, binge-eating disorder, night-eating syndrome, socioeconomic factors, and ethnic factors. The chapter includes an outline, figures and tables; it concludes with an extensive list of references. 8 figures. 7 tables. 100 references.

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Other Complications and Associated Conditions. Pediatric Diabetes. 8: 171-176. 2007.

This article presents information from the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines (2006–2007) on other complications and associated conditions in children with diabetes. Topics covered include impaired growth and development; associated autoimmune conditions, such as hypothyroidism, hyperthyroidism, celiac disease, vitiligo, and primary adrenal insufficiency (Addison disease); lipodystrophy; necrobiosis lipoidica diabeticorum; limited joint mobility; and edema. The authors briefly review the literature on which their discussion is based and then summarize with a set of recommendations. They stress that monitoring of growth and physical development and the use of growth charts are essential elements in the continuous care of children and adolescents with type 1 diabetes. Screening of thyroid function and screening for celiac disease is recommended at the diagnosis of diabetes and thereafter, every second year. Routine clinical examination should be undertaken for skin and joint changes. There is no established therapeutic intervention for lipodystrophy, necrobiosis lipoidica, or limited joint mobility. 81 references.

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Thyroid Disorders. IN: Camacho, P.M.; Gharib, H.; Sizemore, G.W., eds. Evidence-Based Endocrinology. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. pp 31-56.

This chapter on thyroid disorders is from a concise, reference-based handbook that is intended to help busy clinicians with endocrine-related diagnostic and therapeutic decisions required in their practices. Using a modification of the McMaster criteria, the contributors to the text have critically assessed and graded studies, assisting readers in quickly evaluating the articles that have led to practice recommendations. Topics covered in this chapter include evaluation of the thyroid function, thyroid imaging, hyperthyroidism, hypothyroidism, thyroid nodules, thyroid cancer, and euthyroid sick syndrome. For each disease state included, the authors discuss etiology, epidemiology, pathophysiology, diagnosis, and treatment considerations. The chapter includes an outline and an extensive, annotated list of references. 1 table. 79 references.

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Thyroid Gland. IN: Gardner, D.; Shoback, D., eds. Greenspan’s Basic and Clinical Endocrinology. 8th ed. Columbus, OH: McGraw Hill. 2007. pp 209-280.

This chapter about the thyroid gland is from a textbook about endocrinology that describes the scientific principles and clinical management of patients with endocrine-related diseases and disorders. The authors note that the thyroid hormones promote normal fetal and childhood growth and development; regulate heart rate and myocardial contractility; affect gastrointestinal motility and renal water clearance; and modulate the body’s energy expenditure, heat generation, and weight. After a section on embryology, anatomy, and histology, the authors describe thyroid physiology, including the structure and synthesis of thyroid hormones, iodine metabolism, thyroid hormone synthesis and secretion, abnormalities in thyroid hormone synthesis and release, metabolism of thyroid hormones, control of thyroid function and hormone action, physiologic changes in thyroid function, and thyroid autoimmunity. Additional sections review tests of thyroid function and disorders of the thyroid, including hypothyroidism, hyperthyroidism and thyrotoxicosis, thyroid hormone resistance syndromes, nontoxic goiter, thyroiditis, the effects of ionizing radiation on the thyroid gland, and thyroid nodules and thyroid cancer. The chapter includes numerous black-and-white photographs and illustrations; a list of abbreviations is provided. 50 figures. 13 tables. 97 references.

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American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocrine Practice. 12(1): 63-102. January-February 2006.

This article presents medical guidelines for clinical practice for the diagnosis and management of patients with thyroid nodules. The document was prepared as a collaborative effort between the American Association of Clinical Endocrinologists (AACE) and the Associazione Medici Endocrinologi (AME); the group used the AACE protocol for clinical practice guidelines, with rating of available evidence, linking the guidelines to the strength of recommendations. Although most patients with thyroid nodules are asymptomatic, occasionally patients complain of dysphagia, dysphonia, pressure, pain, or symptoms of hyperthyroidism or hypothyroidism. Absence of symptoms does not rule out a malignant lesion, so reviewing the patient‘s risk factors for malignant disease is important. Thyroid ultrasound should not be used as a screening test; however, all patients with a palpable thyroid nodule should undergo ultrasound examination. The introduction of sensitive thyrotropin—thyroid-stimulating hormone, or TSH—assays, the widespread application of fine-needle aspiration (FNA) biopsy, and the availability of high-resolution ultrasound have substantially improved the management of thyroid nodules. The guidelines also include suggestions for thyroid nodule management during pregnancy. 2 figures. 22 tables. 142 references.

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Celiac Disease and Thyroid Conditions. Auburn, WA: Gluten Intolerance Group. December 2006. 2 p.

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